Radiation-Related Hypopharynx-Stenosis with Spared Larynx Treated by a Novel-Shaped Silicone Stent

Background: Radiation-related hypopharyngeal stenoses are considered as complications after larynx sparing therapy of hypopharyngeal or laryngeal tumors. Methods: The reported patient suffered from chondronecrosis of the cricoid after radiation of a larynx carcinoma and was treated by removing the necrotic cartilage. To prevent emerging stenosis of the hypopharynx, a customized hypopharyngeal stent was constructed on the basis of CT scan data. The Y-shaped stent was placed dorsal to the larynx, caudal to the arytenoid cartilages and remained in place without dislocation or irritation of the larynx for 8 weeks. During that time, the hypopharynx was stented, and the mucosa grew around the stent covering the complete circumference of the hypopharynx again. 18 weeks after removal of the stent, the hypopharynx did not reveal any re-stenosis. Conclusion: This customized hypopharyngeal stent is the first reported approach applied with spared larynx, which has been tolerated for a long period of time.

Treatment of Deep Vein Thrombosis Using Factor Xa Inhibitor Concurrent with Platinum Based Chemotherapy Regimen: A Case Report

Deep Vein Thrombosis (DVT) is a common treatment-related complication following surgery and chemotherapy. We are reporting a case of colorectal cancer-associated thrombosis during platinum-based chemotherapy. The patient was treated with Rivaroxaban (Xarelto), a highly selective direct Factor Xa inhibitor. This case report highlights the concurrent use of novel oral anticoagulants, which does not interrupt the chemotherapy schedule among patients receiving cytotoxic agents.

Repeated Middle Meningeal Artery Embolization for Chronic Subdural Hematoma Management: Case Report

Aim: Middle Meningeal Artery (MMA) embolization has emerged as a viable neuroendovascular technique for the management of chronic subdural hematoma (SDH). Comparative analysis of various endovascular techniques for embolization is lacking. Guidance on operative techniques in situations of prior embolization failure is rare. Materials and Methods: In this case report, we present a patient with a chronic subdural hematoma that failed previous coil embolization of the MMA. Digital Subtraction Angiography showed the previously placed coil and continued distal flow to the dural membranes. Results: Onyx liquid embolization was completed successfully, effectively halting both anterograde flow to the MMA and retrograde flow from external circulation collaterals. Conclusion: This case report suggests that in situations of MMA embolization failure, follow-up angiography may be completed to determine if further embolization through other procedural techniques may be possible. The angiographic images contained here highlight the advantages of liquid embolization over coil embolization of the MMA in halting SDH angiogenesis.

Rare Case of Gallbladder Perforation in Pediatric Patient: A Pitfall in Generalized Peritonitis in Late Presented Typhoid Fever

An 11-year-old boy presented to the emergency room with generalized abdominal pain, inability to pass gas nor stool in 2 days, along with stepladder pattern fever which he had been having in the past 2 weeks before being admitted to the hospital. Abdominal surgical complications are one of most common complications (10-15% of typhoid fever patients) in pediatric typhoid fever, but gallbladder perforation is an uncommon one. Emergency surgical exploration with cholecystectomy was initiated and showed satisfying outcome [1].

Hemostasis Surgery of Spontaneous Hemothorax Complicating Neurofibromatosis Type 1

Vascular lesions in Von Recklinghausen’s disease also known as Neurofibromatosis type 1 (NF1), are rare but have a fatal and potentially life threatening complications such as spontaneous hemothorax. An emergent thoracotomy is indicated when there is an active bleeding associated unstable hemodynamic status. Despites surgery is laborious and unpredictable but it have a merit to stop hemorrhage. A conservative management with endovascular embolization or non-operative approach have also been reported in case of hemodynamic stability. We report two case report of spontaneous hemothorax in patient with Recklinghausen disease. A chest tube was immediately inserted for two patients. Due to continuous bleeding and hemodynamic instability (Patient 1), and the increase of pleural effusion volume (Patients 1 & 2), emergent surgery of thorax was done with favourable post-operative follow up.

Colonic Stent as “Bridge to Surgery” and Its Complications: A Case Report

Introduction: Endoluminal colonic stents can be used as a palliative solution in case of neoplastic subocclusions of the bowel and in some cases, they have been proposed as a temporary solution, in place of the derivative stoma, waiting for radical surgery. The "bridge to surgery" solution however can be complicated by perforations or dislocations that can make the patient's cancer treatment more complex. Case Presentation: A seventy-nine-year-old female patient presented a medium sigma adenocarcinoma that was treated initially with a stent to solve the bowel subocclusion. The procedure was complicated by a perforation that leaded to a modification of the TNM stage and consequently of the oncological therapeutic attitude. Conclusion: Self expandable stents could be used to solve the bowel occlusion to replace the derivative stoma performed in urgency. These procedures guarantee a better quality of life and generally less morbidity. However, an accurate assessment of the risks resulting from the positioning of the stents is necessary, avoiding the implant of the stent in tortuous or angled sections of the bowel with a high risk of decubitus and consequently of micro or macro perforations.

Unusual Case of Pseudomyxoma Peritonei of a Mature Teratoma in Adult Men

Pseudomyxoma peritonei (PMP) is a rare disease usually originating from appendiceal neoplasm and its incidence is 1-2 cases per million. Extra-appendicular origin is less common and is related to ovary, urachus, stomach, colon and pancreas cancer. A few cases of mature ovarian teratoma associated with PMP have been described. We report an extremely rare case of a man treated for a mature teratoma recurrence as a PMP. A 57-year-old man with multiple surgeries for mature teratoma excision as a newborn was addressed to our institution. At the age of 55, a surgical exploration found a low-grade PMP. The patient was asymptomatic, and surveillance was performed. Nine months later, a sub-complete cytoreductive surgery (CRS) with Mitomycin C HIPEC (hyperthermic intraperitoneal chemotherapy) was performed. One year later, the residual mass volume was treated by a new CRS with Mitomycin C HIPEC. After a two-year follow-up patient has no recurrence. PMP extra-appendiceal origin in less than 10%. This is the first reported case of PMP originating as a mature teratoma recurrence in a man. A few cases describe PMP from ovarian teratoma in women. Despite PMP’s different origins, gold standard treatment still remains CRS and HIPEC.